Jancic Jasna, Nikolic Blazo, Ivancevic Nikola, Djuric Vesna, Zaletel Ivan, Stevanovic Dejan, Peric Sasa, van den Anker John N, Samardzic Janko
Clinic of Neurology and Psychiatry for Children and Youth, Medical Faculty, University of Belgrade, Belgrade, Serbia.
Institute of Histology and Embryology "Aleksandar Đ. Kostić", Medical Faculty, University of Belgrade, Belgrade, Serbia.
Neurol Ther. 2016 Dec;5(2):131-143. doi: 10.1007/s40120-016-0052-6. Epub 2016 Sep 17.
Multiple sclerosis (MS) is a chronic, autoimmune, inflammatory, demyelinating disease of the central nervous system. MS is increasingly recognized in the pediatric population, and it is usually diagnosed around 15 years of age. The exact etiology of MS is still not known, although autoimmune, genetic, and environmental factors play important roles in its development, making it a multifactorial disease. The disease in children almost always presents in the relapsing-remittent form. The therapy involves treatment of relapses, and immunomodulatory and symptomatic treatment. The treatment of children with MS has to be multidisciplinary and include pediatric neurologists, ophthalmologists, psychologists, physiotherapists, and if necessary, pediatric psychiatrists and pharmacologists. The basis of MS therapy should rely on drugs that are able to modify the course of the disease, i.e. immunomodulatory drugs. These drugs can be subdivided into two general categories: first-line immunomodulatory therapy (interferon beta-1a, interferon beta-1b, glatiramer acetate) and second-line immunomodulatory therapy (natalizumab, mitoxantrone, fingolimod, teriflunomide, azathioprine, rituximab, dimethyl fumarate, daclizumab). Treatment of relapses involves the use of high intravenous doses of corticosteroids, administration of intravenous immunoglobulins, and plasmapheresis. We summarize here the current available information related to the etiology and treatment options in MS. Early administration of immunomodulatory therapy is beneficial in adults, while more studies are needed to prove their effectiveness in pediatric populations. Therefore, pediatric MS still represents a great challenge for both, the early and correct diagnosis, as well as its treatment.
多发性硬化症（MS）是一种中枢神经系统的慢性、自身免疫性、炎症性脱髓鞘疾病。MS在儿童群体中的发病率越来越高，通常在15岁左右被诊断出来。尽管自身免疫、遗传和环境因素在其发展过程中起着重要作用，使其成为一种多因素疾病，但MS的确切病因仍不清楚。儿童期的这种疾病几乎总是以复发缓解型出现。治疗包括复发的治疗、免疫调节治疗和对症治疗。对患有MS的儿童进行治疗必须是多学科的，包括儿科神经科医生、眼科医生、心理学家、物理治疗师，必要时还包括儿科精神科医生和药理学家。MS治疗的基础应该依赖于能够改变疾病进程的药物，即免疫调节药物。这些药物可分为两大类：一线免疫调节治疗（干扰素β-1a、干扰素β-1b、醋酸格拉替雷）和二线免疫调节治疗（那他珠单抗、米托蒽醌、芬戈莫德、特立氟胺、硫唑嘌呤、利妥昔单抗、富马酸二甲酯、达利珠单抗）。复发的治疗包括静脉注射高剂量皮质类固醇、静脉注射免疫球蛋白和血浆置换。我们在此总结目前有关MS病因和治疗选择的可用信息。免疫调节治疗的早期给药对成人有益，而需要更多研究来证明其在儿童群体中的有效性。因此，儿童MS在早期正确诊断及其治疗方面仍然是一个巨大的挑战。
